During the past decade, Practice Partner Research Network (PPRNet) has established a theoretically-informed framework for translating research into practice (TRIP) within small to medium sized primary care practices that use the Practice Partner(R) (McKesson Corporation, Seattle, WA) electronic medical record (EMR). The PPRNet-TRIP Quality Improvement (QI) Model features three components: an intervention model, an improvement model and a practice development model that assists practices with implementation of quality improvement (QI). Using the PPRNet-TRIP QI Model this practice-based research network (PBRN) guided its'member practices to improve quality on a robust set of primary care measures. PPRNet-TRIP QI's intervention model is implemented in practice settings through a combination of performance reports, site visits, and network meetings. The improvement model focuses on prioritizing performance, involving all staff, redesigning the delivery system, patient activation, and using EMR tools. The practice development model helps practices understand and implement QI using seven concepts: leaders setting a vision with clear goals;involving the team;enhancing communication systems;developing the team;taking small steps;assimilating the EMR to maximize clinical effectiveness;and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. This proposed research addresses the use of health information technology (HIT) to improve health care decision-making by evaluating how quality of care is improved while using EMRs, and how to increase the adoption of new roles in practice settings to improve communication between patients and practices about health care. The specific aims of this two year project are to: 1) Complete a mixed methods secondary analysis to synthesize findings related to improving quality using HIT in primary care across seven nationally funded PPRNet initiatives. 2) Examine current perspectives of PPRNet-TRIP study practice participants related to: developing and sustaining QI efforts;and team development for an increasingly more active health care delivery role through robust EMR implementation. 3) Integrate findings from PPRNet's previous studies with the current perspectives of practice representatives to refine the overarching theory-based "PPRNet-TRIP QI Model". The aims and products of the proposed R03 will further the goals of supporting safe, efficient and effective health care for all Americans through use of HIT to improve performance in real world of primary care practices. PUBLIC HEALTH RELEVANCE: NARRATIVE - Coherent conceptual frameworks are needed to activate practices that aim to improve the delivery of primary care using their electronic medical records. The Practice Partner Research Network has used an internally developed conceptual framework for improving quality on a robust set of quality indicators. A systematic secondary analysis and synthesis of quality improvement sustainability and maintenance will provide evidence for refining the well-developed and useful PPRNet-TRIP QI model.